<band height="804">
<rectangle>
<reportElement x="0" y="88" width="557" height="53"/>
<graphicElement>
<pen lineWidth="0.75"/>
</graphicElement>
</rectangle>
<textField>
<reportElement x="103" y="89" width="228" height="16"/>
<textElement lineSpacing="Single">
<font fontName="Tahoma" size="12" isBold="false"/>
</textElement>
<textFieldExpression class="java.lang.String"><![CDATA[$P{nama}]]></textFieldExpression>
</textField>
<textField>
<reportElement x="103" y="106" width="228" height="16"/>
<textElement lineSpacing="Single">
<font fontName="Tahoma" size="12" isBold="false"/>
</textElement>
<textFieldExpression class="java.lang.String"><![CDATA[$P{jkel}]]></textFieldExpression>
</textField>
<textField pattern="">
<reportElement x="103" y="123" width="228" height="16"/>
<textElement lineSpacing="Single">
<font fontName="Tahoma" size="12" isBold="false"/>
</textElement>
<textFieldExpression class="java.lang.String"><![CDATA[$P{lahir}]]></textFieldExpression>
</textField>
<textField>
<reportElement mode="Transparent" x="385" y="89" width="171" height="16"/>
<textElement verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="12" isBold="false"/>
</textElement>
<textFieldExpression class="java.lang.String"><![CDATA[$P{norm}]]></textFieldExpression>
</textField>
<textField>
<reportElement x="385" y="106" width="171" height="16"/>
<textElement lineSpacing="Single">
<font fontName="Tahoma" size="12" isBold="false"/>
</textElement>
<textFieldExpression class="java.lang.String"><![CDATA[$P{ruang}]]></textFieldExpression>
</textField>
<textField>
<reportElement x="385" y="123" width="171" height="16"/>
<textElement lineSpacing="Single">
<font fontName="Tahoma" size="12" isBold="false"/>
</textElement>
<textFieldExpression class="java.lang.String"><![CDATA[$P{kelas}]]></textFieldExpression>
</textField>
<line>
<reportElement x="0" y="56" width="557" height="1"/>
<graphicElement>
<pen lineWidth="1.25"/>
</graphicElement>
</line>
<rectangle>
<reportElement x="510" y="62" width="47" height="20"/>
<graphicElement>
<pen lineWidth="0.75"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement x="510" y="64" width="47" height="18"/>
<textElement textAlignment="Center" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="12"/>
</textElement>
<text><![CDATA[RM 4B]]></text>
</staticText>
<staticText>
<reportElement x="338" y="89" width="40" height="16"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="12"/>
</textElement>
<text><![CDATA[No RM]]></text>
</staticText>
<staticText>
<reportElement x="338" y="106" width="40" height="16"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="12"/>
</textElement>
<text><![CDATA[Ruang]]></text>
</staticText>
<staticText>
<reportElement x="338" y="123" width="40" height="16"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="12"/>
</textElement>
<text><![CDATA[Kelas]]></text>
</staticText>
<staticText>
<reportElement x="378" y="89" width="7" height="16"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="12"/>
</textElement>
<text><![CDATA[:]]></text>
</staticText>
<staticText>
<reportElement x="378" y="106" width="7" height="16"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="12"/>
</textElement>
<text><![CDATA[:]]></text>
</staticText>
<staticText>
<reportElement x="378" y="123" width="7" height="16"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="12"/>
</textElement>
<text><![CDATA[:]]></text>
</staticText>
<line>
<reportElement x="331" y="88" width="1" height="53"/>
<graphicElement>
<pen lineWidth="0.75"/>
</graphicElement>
</line>
<staticText>
<reportElement x="96" y="89" width="7" height="16"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="12"/>
</textElement>
<text><![CDATA[:]]></text>
</staticText>
<staticText>
<reportElement x="8" y="89" width="88" height="16"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="12"/>
</textElement>
<text><![CDATA[Nama Pasien]]></text>
</staticText>
<staticText>
<reportElement x="8" y="106" width="88" height="16"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="12"/>
</textElement>
<text><![CDATA[Jenis Kelamin]]></text>
</staticText>
<staticText>
<reportElement x="8" y="123" width="88" height="16"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="12"/>
</textElement>
<text><![CDATA[Tanggal Lahir]]></text>
</staticText>
<staticText>
<reportElement x="96" y="106" width="7" height="16"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="12"/>
</textElement>
<text><![CDATA[:]]></text>
</staticText>
<staticText>
<reportElement x="96" y="123" width="7" height="16"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="12"/>
</textElement>
<text><![CDATA[:]]></text>
</staticText>
<line>
<reportElement x="0" y="752" width="557" height="1"/>
<graphicElement>
<pen lineWidth="2.0" lineStyle="Solid"/>
</graphicElement>
</line>
<staticText>
<reportElement x="0" y="753" width="230" height="20"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="11"/>
</textElement>
<text><![CDATA[PELAYANAN ANASTESI DAN BEDAH]]></text>
</staticText>
<rectangle>
<reportElement x="0" y="156" width="557" height="586"/>
<graphicElement>
<pen lineWidth="0.75"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement mode="Opaque" x="1" y="157" width="185" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Center" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[SIGN IN]]></text>
</staticText>
<staticText>
<reportElement mode="Opaque" x="186" y="157" width="185" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Center" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[TIME OUT]]></text>
</staticText>
<staticText>
<reportElement mode="Opaque" x="372" y="157" width="185" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Center" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[SIGN OUT]]></text>
</staticText>
<staticText>
<reportElement mode="Opaque" x="1" y="165" width="185" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Center" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[(Sebelum Induksi Anestesi)]]></text>
</staticText>
<staticText>
<reportElement mode="Opaque" x="186" y="165" width="185" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Center" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[(Sebelum Insisi Kulit)]]></text>
</staticText>
<staticText>
<reportElement mode="Opaque" x="372" y="165" width="185" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Center" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[(Sebelum Pasien Keluar Kamar Operasi)]]></text>
</staticText>
<line>
<reportElement x="0" y="175" width="557" height="1"/>
<graphicElement>
<pen lineWidth="0.5"/>
</graphicElement>
</line>
<staticText>
<reportElement mode="Opaque" x="1" y="176" width="185" height="19" backcolor="#E3EDFD"/>
<textElement textAlignment="Center" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Dilakukan oleh perawat dan dokter anestesi]]></text>
</staticText>
<staticText>
<reportElement mode="Opaque" x="186" y="176" width="185" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Center" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Dilakukan oleh perawat, dokter anestesi]]></text>
</staticText>
<staticText>
<reportElement mode="Opaque" x="186" y="185" width="185" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Center" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[ dan ahli bedah]]></text>
</staticText>
<staticText>
<reportElement mode="Opaque" x="372" y="185" width="185" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Center" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[ dan ahli bedah]]></text>
</staticText>
<staticText>
<reportElement mode="Opaque" x="372" y="176" width="185" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Center" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Dilakukan oleh perawat, dokter anestesi]]></text>
</staticText>
<line>
<reportElement x="0" y="195" width="557" height="1"/>
<graphicElement>
<pen lineWidth="0.75"/>
</graphicElement>
</line>
<staticText>
<reportElement mode="Transparent" x="0" y="197" width="185" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[ VERIFIKASI]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="186" y="197" width="185" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[ KELENGKAPAN TIM DAN FASILITAS OPERASI]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="372" y="197" width="185" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[ BACA SECARA VERBAL]]></text>
</staticText>
<elementGroup/>
<staticText>
<reportElement mode="Transparent" x="21" y="206" width="164" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Identitas dan gelang pasien]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="21" y="215" width="164" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Informed consent]]></text>
</staticText>
<rectangle>
<reportElement x="11" y="207" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<rectangle>
<reportElement x="11" y="216" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement mode="Transparent" x="33" y="224" width="152" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Dokter Bedah]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="33" y="233" width="152" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Dokter Anestesi]]></text>
</staticText>
<rectangle>
<reportElement x="23" y="225" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<rectangle>
<reportElement x="23" y="234" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement mode="Transparent" x="11" y="242" width="59" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[- Nama operator]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="11" y="251" width="59" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[- Nama anestesi]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="11" y="260" width="59" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[- Nama tindakan]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="70" y="242" width="115" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[:________________________]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="70" y="251" width="115" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[:________________________]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="70" y="260" width="115" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[:________________________]]></text>
</staticText>
<rectangle>
<reportElement x="11" y="270" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement mode="Transparent" x="21" y="269" width="164" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Pemberian tanda di lokasi operasi]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="33" y="278" width="152" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Ya]]></text>
</staticText>
<rectangle>
<reportElement x="23" y="279" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement mode="Transparent" x="33" y="287" width="152" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Tidak]]></text>
</staticText>
<rectangle>
<reportElement x="23" y="288" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement mode="Transparent" x="0" y="302" width="185" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[ PEMERIKSAAN KELENGKAPAN ANESTESI]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="21" y="311" width="164" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Mesin anestesi]]></text>
</staticText>
<rectangle>
<reportElement x="11" y="312" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement mode="Transparent" x="21" y="320" width="164" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Obat-obatan]]></text>
</staticText>
<rectangle>
<reportElement x="11" y="321" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement mode="Transparent" x="21" y="329" width="164" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Pulse oximeter]]></text>
</staticText>
<rectangle>
<reportElement x="11" y="330" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement mode="Transparent" x="21" y="338" width="164" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Laboratorium]]></text>
</staticText>
<rectangle>
<reportElement x="11" y="339" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement mode="Transparent" x="21" y="347" width="164" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[IV line]]></text>
</staticText>
<rectangle>
<reportElement x="11" y="348" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement mode="Transparent" x="0" y="362" width="185" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[ PEMERIKSAAN TANDA]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="11" y="371" width="59" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[- Tekanan darah]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="70" y="371" width="115" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[:________________________]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="11" y="380" width="59" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[- Nadi]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="11" y="389" width="59" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[- Pernafasan]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="11" y="398" width="59" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[- Saturasi O2]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="11" y="407" width="59" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[- Suhu]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="70" y="380" width="115" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[:________________________]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="70" y="389" width="115" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[:________________________]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="70" y="398" width="115" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[:________________________]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="70" y="407" width="115" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[:________________________]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="0" y="422" width="185" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[ RIWAYAT ALERGI]]></text>
</staticText>
<rectangle>
<reportElement x="11" y="432" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement mode="Transparent" x="21" y="431" width="164" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Ada, keterangan :_____________________]]></text>
</staticText>
<rectangle>
<reportElement x="11" y="441" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement mode="Transparent" x="21" y="440" width="164" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Tidak ada]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="0" y="455" width="185" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[ RISIKO ASPIRASI ATAU GANGGUAN PERNAFASAN]]></text>
</staticText>
<rectangle>
<reportElement x="11" y="465" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement mode="Transparent" x="21" y="464" width="164" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Tidak]]></text>
</staticText>
<rectangle>
<reportElement x="11" y="474" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement mode="Transparent" x="21" y="473" width="164" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Ya, dengan bantuan alat]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="0" y="488" width="185" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[ RISIKO PERDARAHAN]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="0" y="497" width="185" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="7"/>
</textElement>
<text><![CDATA[ Kehilangan darah >500 ml (7 ml/kg pada anak-anak)]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="21" y="506" width="164" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Tidak]]></text>
</staticText>
<rectangle>
<reportElement x="11" y="507" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement mode="Transparent" x="21" y="515" width="164" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Ya, dengan dua IV line atau CVC]]></text>
</staticText>
<rectangle>
<reportElement x="11" y="516" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement mode="Transparent" x="0" y="530" width="185" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[ RENCANA ANESTESI]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="21" y="539" width="164" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Umum]]></text>
</staticText>
<rectangle>
<reportElement x="11" y="540" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement mode="Transparent" x="21" y="548" width="164" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Spinal]]></text>
</staticText>
<rectangle>
<reportElement x="11" y="549" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement mode="Transparent" x="21" y="557" width="164" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Blok]]></text>
</staticText>
<rectangle>
<reportElement x="11" y="558" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement mode="Transparent" x="21" y="566" width="164" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Lokal]]></text>
</staticText>
<rectangle>
<reportElement x="11" y="567" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<rectangle>
<reportElement x="197" y="207" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement mode="Transparent" x="207" y="206" width="164" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Lengkap]]></text>
</staticText>
<rectangle>
<reportElement x="197" y="216" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement mode="Transparent" x="207" y="215" width="164" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Tidak lengkap, Alasan :_________________]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="186" y="230" width="185" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[ PERIKSA KELENGKAPAN PERALATAN OPERASI]]></text>
</staticText>
<rectangle>
<reportElement x="197" y="240" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement mode="Transparent" x="207" y="239" width="164" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Instrument]]></text>
</staticText>
<rectangle>
<reportElement x="197" y="249" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement mode="Transparent" x="207" y="248" width="164" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Kasa]]></text>
</staticText>
<rectangle>
<reportElement x="197" y="258" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement mode="Transparent" x="207" y="257" width="164" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Jarum]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="186" y="272" width="185" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[ BACA SECARA VERBAL]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="207" y="281" width="164" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Tanggal tindakan]]></text>
</staticText>
<rectangle>
<reportElement x="197" y="282" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement mode="Transparent" x="207" y="290" width="164" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Identitas pasien]]></text>
</staticText>
<rectangle>
<reportElement x="197" y="291" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement mode="Transparent" x="207" y="299" width="164" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Nama tindakan]]></text>
</staticText>
<rectangle>
<reportElement x="197" y="300" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement mode="Transparent" x="207" y="308" width="164" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Prosedur tindakan]]></text>
</staticText>
<rectangle>
<reportElement x="197" y="309" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement mode="Transparent" x="207" y="317" width="164" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Lokasi Tindakan]]></text>
</staticText>
<rectangle>
<reportElement x="197" y="318" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement mode="Transparent" x="207" y="326" width="164" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Informed consent]]></text>
</staticText>
<rectangle>
<reportElement x="197" y="327" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement mode="Transparent" x="186" y="341" width="185" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[ PREMEDIKASI]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="207" y="350" width="164" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Tidak ada]]></text>
</staticText>
<rectangle>
<reportElement x="197" y="351" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<rectangle>
<reportElement x="197" y="360" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement mode="Transparent" x="207" y="359" width="164" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Ada :]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="197" y="368" width="174" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Nama obat :____________________________]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="197" y="387" width="174" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Tgl / jam diberikan :_____________________]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="241" y="378" width="129" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[____________________________]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="270" y="396" width="100" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[_____________________]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="186" y="411" width="185" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[ ANTIBIOTIK PROFILAKSIS]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="186" y="420" width="185" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[ Apakah sudah diberikan dalam waktu sekurangnya]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="186" y="429" width="185" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[ 60 menit ?]]></text>
</staticText>
<rectangle>
<reportElement x="197" y="439" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement mode="Transparent" x="207" y="438" width="164" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Ya]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="197" y="447" width="174" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Nama obat :____________________________]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="197" y="456" width="174" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Dosisi obat :____________________________]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="197" y="465" width="174" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Jam diberikan :__________________________]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="207" y="474" width="164" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Tidak]]></text>
</staticText>
<rectangle>
<reportElement x="197" y="475" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement mode="Transparent" x="186" y="489" width="185" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[ FOTO PEMERIKSAAN RADIOLOGI YANG]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="186" y="498" width="185" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[ DIPERLUKAN]]></text>
</staticText>
<rectangle>
<reportElement x="197" y="508" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement mode="Transparent" x="207" y="507" width="164" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Dipasang]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="207" y="516" width="164" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Tidak dipasang]]></text>
</staticText>
<rectangle>
<reportElement x="197" y="517" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement mode="Transparent" x="393" y="206" width="164" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Nama tindakan]]></text>
</staticText>
<rectangle>
<reportElement x="383" y="207" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement mode="Transparent" x="372" y="221" width="185" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[ PERIKSA KELENGKAPAN SEBELUM LUKA ]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="372" y="230" width="185" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[ OPERASI DITUTUP]]></text>
</staticText>
<rectangle>
<reportElement x="383" y="240" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement mode="Transparent" x="393" y="239" width="164" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Instrument]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="393" y="257" width="164" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Jarum]]></text>
</staticText>
<rectangle>
<reportElement x="383" y="258" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<rectangle>
<reportElement x="383" y="249" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement mode="Transparent" x="393" y="248" width="164" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Kasa]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="372" y="272" width="185" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[ PERIKSA KELENGKAPAN BAHAN PEMERIKSAAN]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="383" y="281" width="174" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[- Preparat]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="404" y="291" width="152" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Ya]]></text>
</staticText>
<rectangle>
<reportElement x="394" y="292" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<rectangle>
<reportElement x="408" y="301" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement mode="Transparent" x="418" y="300" width="138" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[PA]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="418" y="309" width="138" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Kultur]]></text>
</staticText>
<rectangle>
<reportElement x="408" y="310" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<rectangle>
<reportElement x="408" y="319" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement mode="Transparent" x="418" y="318" width="138" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Sitologi]]></text>
</staticText>
<rectangle>
<reportElement x="394" y="328" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement mode="Transparent" x="404" y="327" width="152" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Tidak]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="383" y="336" width="174" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[- Formulir permintaan pemeriksaan]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="404" y="346" width="152" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Ya]]></text>
</staticText>
<rectangle>
<reportElement x="394" y="347" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<rectangle>
<reportElement x="394" y="356" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement mode="Transparent" x="404" y="355" width="152" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Tidak]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="404" y="383" width="152" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Tidak]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="383" y="364" width="174" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[- Telah dilengkapi identitas pasien]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="404" y="374" width="152" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Ya]]></text>
</staticText>
<rectangle>
<reportElement x="394" y="375" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<rectangle>
<reportElement x="394" y="384" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement mode="Transparent" x="404" y="411" width="152" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Ya]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="383" y="392" width="174" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8" isBold="false"/>
</textElement>
<text><![CDATA[- Penjelasan oleh operator kepada keluarga]]></text>
</staticText>
<rectangle>
<reportElement x="394" y="421" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<rectangle>
<reportElement x="394" y="412" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement mode="Transparent" x="404" y="420" width="152" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Tidak, alasan :_____________________]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="388" y="401" width="167" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8" isBold="false"/>
</textElement>
<text><![CDATA[pasien]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="372" y="435" width="185" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[ OBAT-OBATAN YANG DIBERIKAN SELAMA]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="372" y="444" width="185" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[ OPERASI]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="394" y="453" width="164" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Diberiksan, alasan :____________________]]></text>
</staticText>
<rectangle>
<reportElement x="384" y="454" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement mode="Transparent" x="394" y="462" width="164" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Tidak diberiksan, alasan :_______________]]></text>
</staticText>
<rectangle>
<reportElement x="384" y="463" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement mode="Transparent" x="372" y="477" width="185" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[ PEMERIKSAAN TANDA VITAL]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="383" y="487" width="59" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[- Kesadaran]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="442" y="487" width="115" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[:________________________]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="442" y="496" width="115" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[:________________________]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="383" y="496" width="59" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[- Tekanan darah]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="383" y="505" width="59" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[- Nadi]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="442" y="505" width="115" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[:________________________]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="442" y="514" width="115" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[:________________________]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="383" y="514" width="59" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[- Pernafasan]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="442" y="523" width="115" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[:________________________]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="383" y="523" width="59" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[- Saturasi O2]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="442" y="532" width="115" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[:________________________]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="383" y="532" width="59" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[- Suhu]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="442" y="541" width="115" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[:________________________]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="383" y="541" width="59" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[- Skala nyeri]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="372" y="556" width="185" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[ PERIKSA KEMBALI LUKA OPERASI]]></text>
</staticText>
<rectangle>
<reportElement x="383" y="566" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<rectangle>
<reportElement x="383" y="575" width="7" height="7"/>
<graphicElement>
<pen lineWidth="0.25"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement mode="Transparent" x="393" y="574" width="164" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Tidak ada rembesan]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="393" y="565" width="164" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Ada rembesan]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="3" y="612" width="83" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[TANGGAL VERIFIKASI]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="86" y="612" width="99" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[:____________________]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="3" y="622" width="83" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[JAM VERIFIKASI]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="86" y="622" width="99" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[:____________________]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="3" y="632" width="182" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[NAMA DAN TANDA TANGAN]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="186" y="632" width="182" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[ NAMA DAN TANDA TANGAN]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="372" y="632" width="182" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[ NAMA DAN TANDA TANGAN]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="3" y="705" width="85" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Center" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Perawat sirkuler]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="88" y="705" width="97" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Center" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Dokter anestesi]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="186" y="705" width="66" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Center" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Perawat sirkuler]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="251" y="705" width="59" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Center" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Dokter bedah]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="309" y="705" width="59" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Center" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Dokter anestesi]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="496" y="705" width="59" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Center" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Dokter anestesi]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="372" y="705" width="66" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Center" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Perawat sirkuler]]></text>
</staticText>
<staticText>
<reportElement mode="Transparent" x="437" y="705" width="59" height="10" backcolor="#E3EDFD"/>
<textElement textAlignment="Center" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<text><![CDATA[Dokter bedah]]></text>
</staticText>
<line>
<reportElement x="185" y="156" width="1" height="586"/>
<graphicElement>
<pen lineWidth="0.75"/>
</graphicElement>
</line>
<line>
<reportElement x="371" y="156" width="1" height="586"/>
<graphicElement>
<pen lineWidth="0.75"/>
</graphicElement>
</line>
<textField pattern="dd/MM/yyyy" isBlankWhenNull="true">
<reportElement mode="Transparent" x="89" y="611" width="83" height="10"/>
<textElement verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8" isBold="false"/>
</textElement>
<textFieldExpression class="java.util.Date"><![CDATA[$F{tanggal}]]></textFieldExpression>
</textField>
<textField pattern="HH:mm:ss" isBlankWhenNull="true">
<reportElement mode="Transparent" x="89" y="621" width="83" height="10"/>
<textElement verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8" isBold="false"/>
</textElement>
<textFieldExpression class="java.sql.Time"><![CDATA[$F{jam}]]></textFieldExpression>
</textField>
<textField>
<reportElement x="2" y="6" width="553" height="17"/>
<textElement textAlignment="Center" lineSpacing="Single">
<font fontName="Tahoma" size="12"/>
</textElement>
<textFieldExpression class="java.lang.String"><![CDATA[$P{namars}]]></textFieldExpression>
</textField>
<textField>
<reportElement x="2" y="20" width="553" height="14"/>
<textElement textAlignment="Center" lineSpacing="Single">
<font fontName="Tahoma" size="9"/>
</textElement>
<textFieldExpression class="java.lang.String"><![CDATA[$P{alamatrs}+", "+$P{kotars}+", "+$P{propinsirs}]]></textFieldExpression>
</textField>
<image scaleImage="FillFrame" onErrorType="Blank">
<reportElement x="0" y="8" width="48" height="45"/>
<imageExpression class="java.io.InputStream"><![CDATA[$P{logo}]]></imageExpression>
</image>
<textField>
<reportElement x="2" y="31" width="553" height="14"/>
<textElement textAlignment="Center" lineSpacing="Single">
<font fontName="Tahoma" size="9"/>
</textElement>
<textFieldExpression class="java.lang.String"><![CDATA[$P{kontakrs}]]></textFieldExpression>
</textField>
<textField>
<reportElement x="2" y="41" width="553" height="14"/>
<textElement textAlignment="Center" lineSpacing="Single">
<font fontName="Tahoma" size="9"/>
</textElement>
<textFieldExpression class="java.lang.String"><![CDATA["E-mail : "+$P{emailrs}]]></textFieldExpression>
</textField>
</band>